UNCONTROLLED WHEN PRINTED
 Introduction
  • Droperidol is a neuroleptic, antipsychotic agent that acts on Alpha and Dopamine receptors, resulting in sedation
  • Onset of effect usually 3-5 mins both IM and IV
  • Use of a sedative agent should never be considered routine. Have a high threshold to offer or administer.
     Indications
    • Disturbed and Abnormal Behaviour (RASS 1 ~ 3) if considered appropriate where risk to safety is evident and de-escalation has not been effective.
    • Dementia and frail patients where Olanzapine cannot be administered or is ineffective.
     Contraindications
    • Known allergy
    • Known Parkinson’s Disease
    • Where Ketamine has been administered to sedate this episode
    • Age < 6 years old
    • Post-ictal Disturbed & Abnormal Behaviour
     Precautions / Notes
    • Address organic causes for behavioural presentations at all times- eg. CVA, TBI, Hypoxia, Hypoglycaemia, etc
    • Post-ROSC agitation - consult ASMA / SOC CSP
    • Dementia patients – apply caution. Use lower doses
    • Agitated or Excited Delirium’, ‘Acute Behavioural Disturbance’ and ‘Drug Induced Psychosis’ are some alternative terms that may be used by other agencies
    Sedation warnings
    • Sedation is HIGH RISK – must only be carried out after careful deliberation between officers and must not be based primarily at the request or influence of other agencies on scene (e.g. Police etc.)
    • Positive RASS score does not automatically infer a need to sedate
    • Age <16 years old – sedation should prompt a prior ASMA consult wherever practicable
    • ETOH / Intoxication – apply caution
    • Repeat & Maintenance doses – have a low threshold to consult with ASMA where repeat or maintenance doses are required
    • Monitoring – SpO2 and EtCO2 monitoring must be applied whenever level of consciousness drops (~RASS -2 or below)
    • Positioning – DO NOT transport in supine position (increases risk of laryngospasm from secretions) – transport in lateral position
    • Airway & Breathing – monitor airway and breathing effort, including chest movement closely for signs of impairment. Prepare to support if required
    • Restraint – Prone and/or handcuffed to rear carries excessive risk and MUST NOT occur. Physical restraint in any position that amplifies the risk of positional asphyxia, must be closely observed for signs of air hunger and hypoxia
    • RASS scores must be agreed and documented
    • Weight – Estimated weight must be agreed before administration of any weight based medicines. This must be documented

    The final decision to sedate lies with the most senior clinician on scene

     Preparation

    IM

    • Do NOT dilute

    IV / IO

    • Dilute 10 mg/2 ml with 8 ml NaCl (equivalent to 1 mg/ml)
    MUST BE LABELLED
     Management
     Weight-based Calculations
     
    Clear
     kg 
    Mode: 
    Weight: 
    IM Droperidol for sedation
    Presentation: 10mg:2mL (5mg/mL)
    Calculated dose:  in
    < 70 years old:
    • 5.00 mg in moderate to severe alcohol intoxication
    • 10.00 mg in nil to mild alcohol intoxication
    ≥ 70 years old or frail:
    • 2.50 mg in moderate to severe alcohol intoxication
    • 5.00 mg in nil to mild alcohol intoxication
    IV Droperidol for sedation
    Presentation: 10mg:10mL (1mg/mL)
    Calculated dose:  in
    < 70 years old:
    • 2.50 - 5.00 mg titrate to effect
    ≥ 70 years old or frail:
    • 2.50mg in 2.50mL

    Administration limited to those with independent authority to practice per the  Medications Schedule

    Adults < 70 years old: 

    • IM (preferred route):
      • 5 mg in moderate to severe alcohol intoxication OR
      • 10 mg in nil to mild alcohol intoxication
    • IV:
      • 2.5 - 5 mg titrate to effect
    • Repeat as necessary each 15 mins to a maximum cumulative dose 20 mg/24 hrs (via all routes). Consider switch to IV Midazolam only if necessary after maximum dose reached.

    Adults > 70 years of age or frail or with dementia:

    • IM (preferred route):
      • 2.5 mg in moderate to severe alcohol intoxication OR
      • 5 mg in nil to mild alcohol intoxication
    • IV:
      • 2.5 mg
    • Repeat as necessary each 15 mins to a maximum cumulative dose 10 mg/24 hrs (via all routes). Consider switch to IV Midazolam  only if necessary after maximum dose reached.

    Paediatrics 6-16 years old:

    • IM (preferred route):
      • 0.2 mg/kg to a maximum of 5 mg
      • Repeat as necessary each 15 mins to a maximum cumulative dose 10 mg/24 hrs (via all routes).
    • IV:
      • 0.2 mg/kg to a maximum of 5 mg 
      • Repeat as necessary each 30 mins to a maximum cumulative dose 10 mg/24 hrs (via all routes).
     Special Considerations
    • Extrapyramidal effects / Dyskinesia
    • Increased falls risk
    • Hypotension
    • Apply monitoring as soon as practicable
    Presentation

    10 mg/2 ml (equivalent to 5 mg/ml)

    DORM vial

    Settings
    Current mode:
    Extended Care:
    Colour assist:

    References
    References

    Document Control


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    Clinical Services

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    Head of Clinical Services

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